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Another Daft T2D Q from Quill! :)

1

198d

Well-Known Member
Relationship to Diabetes
At risk of diabetes
So since I joined the forum and started reading bits here and there, I do feel like I’ve learned a bit more about it all (kind of) but one thing that I’ve never found a definitive answer to is:

Once your first blood test is found to be over that HbA1c threshold of 48, are you then just T2 Diabetic and that’s it for life - whether you get below 48 and into remission or bring it back under 42/back down to the 30’s?

Or is it simply:

48 and over - Diabetic
42-47 - Pre Diabetic
Below 42 - Not Diabetic wahoo well done!

Honestly sorry for being thick but I’ve not once seen it explained in a way that my brain fully computes.
Explain it to me like I’m 5. No really! o_O
 
Dunno if I can really - can you read properly yet? :rofl:
 
Never cured - but can be 'in remission'. Dunno overall but FWIW my husband (77 on Friday and has COPD, recently had his AAA stented, had a prostatectomy due to cancer 15 ish years ago) who gets a blood test 'for everything' annually happened to say one day last week that his last HbA1c, in 2024, was 39. So I reckon probably that anything up to 41 is 'normal' and anything over should be queried.
 
Does cause a lot of confusion @Quill. Comes back to the idea that different people see diabetes differently.

If you think about it as a disease then your definitions work. You have it (over 48), might get it (42-47) or don't have it (under 42)

If you think about it as something about the way your system works and unless you work at it to keep below 48 you might end up with unwanted consequences, then it is something you have and where it shows up on the diabetes scale depends on how well you have it under control.

I prefer the second way if only because it is a reminder that I'd better keep doing the things I did to get my Hba1c down otherwise its pretty certain I would end up back where I started from.
 
Quill said:
So since I joined the forum and started reading bits here and there, I do feel like I’ve learned a bit more about it all (kind of) but one thing that I’ve never found a definitive answer to is:

Once your first blood test is found to be over that HbA1c threshold of 48, are you then just T2 Diabetic and that’s it for life - whether you get below 48 and into remission or bring it back under 42/back down to the 30’s?

Or is it simply:

48 and over - Diabetic
42-47 - Pre Diabetic
Below 42 - Not Diabetic wahoo well done!

Honestly sorry for being thick but I’ve not once seen it explained in a way that my brain fully computes.
Explain it to me like I’m 5. No really! o_O
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Hi there, the 48 diagnostic point is 6.5% in measures that were used before the EU directive circa 2012 switched the system.
WHO had chosen 6.5% as an important cut off point in diagnosing Type 2 Diabetes because that was the point at which cvd significantly accelerated. Cardio issues being the main complication of Type 2 that was felt to be most important. (Type 2 D is effectively regarded as a species of heart/cardio disease ).
Once diagnosed securely with Type 2 Diabetes other diagnostic categories ( pre-diabetes, 'normal' ) become irrelevant. In the current state of knowledge Type 2 Diabetes is for life and any HbA1cs will be those of a diabetic whatever they are ; showing good control, satisfactory control or poor control depending on targets for age,stage and duration of diabetes.

---------–--------------------
'All is changed, changed utterly
A terrible beauty is born.'
W.B. Yeats, Easter 1916
 
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Docb said:
Does cause a lot of confusion @Quill. Comes back to the idea that different people see diabetes differently.

If you think about it as a disease then your definitions work. You have it (over 48), might get it (42-47) or don't have it (under 42)

If you think about it as something about the way your system works and unless you work at it to keep below 48 you might end up with unwanted consequences, then it is something you have and where it shows up on the diabetes scale depends on how well you have it under control.

I prefer the second way if only because it is a reminder that I'd better keep doing the things I did to get my Hba1c down otherwise its pretty certain I would end up back where I started from.
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Cheers Doc!
Everything I’ve seen since I actually posted says yeah Diabetic over 48 (luckily mine was only 51) and that’s you for life so I think I was just kidding myself thinking I could get out of it before I got the Dx so to speak.

Bloods on Jan 31st so we shall see 🙂
 
The numbers are very confusing - mine was only 49 at Type 1 diagnosis (caught it at the right time, I guess!) - I'm aiming for 58 so I can get HCL (that's a joke btw!) - Libre says it's now 40 but had so many false low readings I don't trust it - got 1st part of my annual review tomorrow, so will get the result soon - Good luck with your tests on the 31st @Quill
 
mashedupmatt said:
The numbers are very confusing - mine was only 49 at Type 1 diagnosis (caught it at the right time, I guess!) - I'm aiming for 58 so I can get HCL (that's a joke btw!) - Libre says it's now 40 but had so many false low readings I don't trust it - got 1st part of my annual review tomorrow, so will get the result soon - Good luck with your tests on the 31st @Quill
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Fingers crossed for good results all round :care:
 
My surgery takes the view that once you are diagnosed you are considered diabetic for life. You therefore get tested annually for everything diabetic related, even if you do manage to get your HbA1c below 42 and are considered in remission. I'm quite happy with this, as I know how easy it is to slip back into bad habits. I also look on it as a well-person check.
 
To be honest, it very much depends who you speak to.

Remission is a relatively new concept for T2 in UK. Some Docs subscribe to it, and others resist the idea.

I have had one diabetic level HbA1c, but it was 73, the 37 or under since, and for several years 33 or under. My old GP took me off the diabetes register. Diabetes has never been discussed with my new GP (since summer). I still have at least annual A1cs (at least because a GP will often throw an HbA1c test in with other routine bloods), and I still have eye screening.

Don't sweat the label for now. I'd urge you to concentrate on decent control, a good, enjoyable lifestyle and living your life.
 
I think NICE guidance is that you should have two HbA1c results of 48 or more to get a definitive diagnosis or one result of 48 or more plus obvious symptoms of diabetes, to rule out the chance of a lab error or a blood disorder giving a falsely elevated HbA1c, but I think it depends if the GP follows the NICE guidance. I would say that if you have only one HbA1c result above 47 and no symptoms and your next HbA1c result is below 48 then theoretically you could argue that you shouldn't be given a formal diagnosis, but if you have had to put effort into losing weight and changing your diet to achieve that reduction, then in reality you have just managed it well enough in that short term to bring the levels down but the original HbA1c was likely correct, so yes, you have diabetes. ie the original result was probably correct and you crossed the threshold to get the diagnosis but have since (hopefully) pushed it back. Lab errors can happen and conditions like anaemia can cause HbA1c to be falsely elevated, but these are quite rare occurrences and if you have obvious risk factors like carrying too much weight and/or have been too sedentary and/or have family history of diabetes and/or perhaps a poor diet, then those clinical factors could be used as further evidence to support a single diagnostic HbA1c (of 51 in your case).

As others have said, there are benefits in having that diabetes diagnosis in that you get at least annual health checks which can highlight other issues if they arise, as well as keep an eye on your diabetes management. The biggest risk factor with diabetes is it going undetected for too long and/or uncontrolled, so in some respects being diagnosed at a low level as you are and having annual checks to keep an eye on things and if necessary support you with your management of it, if things deteriorate is far better than not getting those annual checks and you losing focus/motivation with your lifestyle changes or perhaps your body changing maybe as a result of a virus somewhere down the line and that change not being spotted because you don't get those annual checks.
 
Don't think they ever say "cured" but "in remission." My late Dad in Law's neighbour lost weight and dropped from a diabetic reading to a normal one i.e.not even pre-diabetic. Her GP said she was in remission but was not cured. Not sure if other GPs would think differently.

I went pre-diabetic a few years ago, got back to a normal reading. My GP said as I had had two years of "normal" results she would cut down the frequency of the hba1c as they still needed to check it. I thought they would let it go completely as I had never been diabetic but they wouldn't. Not sure though if that is because I am older - 71 - and it is classed as an "ageing" disease i.e. you are more insulin resistant when you are older than when you are younger "in general." There are always exceptions.
 
rebrascora said:
I think NICE guidance is that you should have two HbA1c results of 48 or more to get a definitive diagnosis or one result of 48 or more plus obvious symptoms of diabetes, to rule out the chance of a lab error or a blood disorder giving a falsely elevated HbA1c, but I think it depends if the GP follows the NICE guidance. I would say that if you have only one HbA1c result above 47 and no symptoms and your next HbA1c result is below 48 then theoretically you could argue that you shouldn't be given a formal diagnosis, but if you have had to put effort into losing weight and changing your diet to achieve that reduction, then in reality you have just managed it well enough in that short term to bring the levels down but the original HbA1c was likely correct, so yes, you have diabetes. ie the original result was probably correct and you crossed the threshold to get the diagnosis but have since (hopefully) pushed it back. Lab errors can happen and conditions like anaemia can cause HbA1c to be falsely elevated, but these are quite rare occurrences and if you have obvious risk factors like carrying too much weight and/or have been too sedentary and/or have family history of diabetes and/or perhaps a poor diet, then those clinical factors could be used as further evidence to support a single diagnostic HbA1c (of 51 in your case).

As others have said, there are benefits in having that diabetes diagnosis in that you get at least annual health checks which can highlight other issues if they arise, as well as keep an eye on your diabetes management. The biggest risk factor with diabetes is it going undetected for too long and/or uncontrolled, so in some respects being diagnosed at a low level as you are and having annual checks to keep an eye on things and if necessary support you with your management of it, if things deteriorate is far better than not getting those annual checks and you losing focus/motivation with your lifestyle changes or perhaps your body changing maybe as a result of a virus somewhere down the line and that change not being spotted because you don't get those annual checks.
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Barbara, you are - as always, very excellent.
Think that’s what I needed to hear/read.

Thank you so much.
We’ll see what comes of next bloods and GP chat
 
Quill said:
Once your first blood test is found to be over that HbA1c threshold of 48, are you then just T2 Diabetic and that’s it for life - whether you get below 48 and into remission or bring it back under 42/back down to the 30’s?
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You need two hba1c above 48 for a diagnosis of T2, then you’re T2 for life.

If you get two hba1cs under 42, 3 months or more apart, without diabetes medication, then you can upgrade to T2 - in remission

But you’re still t2 and still need the checks
 
Lucyr said:
You need two hba1c above 48 for a diagnosis of T2, then you’re T2 for life.

If you get two hba1cs under 42, 3 months or more apart, without diabetes medication, then you can upgrade to T2 - in remission

But you’re still t2 and still need the checks
Click to expand...
So I had HBa1c of 89 in the summer. Nurse said not to bother with second test as it was so high. In the autumn had second test that came back at 30. In that case, according to the above I should not have a T2D diagnosis and do not need to declare it for insurance purposes etc? Is that correct? Can you point me towards anything official to confirm this ? Would save me a few quidd if you could!
 
effayjay said:
So I had HBa1c of 89 in the summer. Nurse said not to bother with second test as it was so high. In the autumn had second test that came back at 30. In that case, according to the above I should not have a T2D diagnosis and do not need to declare it for insurance purposes etc? Is that correct? Can you point me towards anything official to confirm this ? Would save me a few quidd if you could!
Click to expand...
Once diagnosed as T2 then you are always T2 but for insurance purposes I always put T2 dietary managed no medication.
There should be no difference in premiums.
 
effayjay said:
So I had HBa1c of 89 in the summer. Nurse said not to bother with second test as it was so high
Click to expand...
If the nurse has put t2 on your records then you need to declare on insurance. One hba1c can be used if the person has symptoms of diabetes.
 
Leadinglights said:
Once diagnosed as T2 then you are always T2 but for insurance purposes I always put T2 dietary managed no medication.
There should be no difference in premiums.
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The point here is that to get the diagnosis in the first place is there is supposed to be 2 hba1c above 48 or one with clear diabetic symptoms (according to NICE anyway). Being at 89 it’s a long way from questionable in most situations I agree but the letter of the law (NICE) may not have been followed depending what else was going on. Symptoms or no symptoms. A sensible explanation of a temporary jump (steroids, Covid something else?) other than diabetes. A discussion with the GP sounds in order. That all said as a type 2 managed by diet alone I’ve never had premiums increased for anything for that reason and my understanding is I shouldn’t. Maybe questions should be asked of the insurer too.
 
Dragonheart said:
The point here is that to get the diagnosis in the first place is there is supposed to be 2 hba1c above 48 or one with clear diabetic symptoms
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It doesn’t matter what’s supposed to happen, if your medical records say you have t2 then you must declare it to insurance or it won’t be valid.
 
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